DiversityNursing Blog

Every student nurse needs to have a strong understanding of culture and ethnic considerations so that they may be able to care for their patient's as whole. Many nurses when not faced with diversity are not fully understanding to exactly what culture is.

Culture is a set of learned values, customs, practices and beliefs that are shared by a group of people or are passed from one generation to another. A subculture shares many of the same characteristics with a primary culture but they may have patterns of behavior or ideals that differ and separate themselves from the rest of a cultural group.

Not all members of a culture will have the same behavior though; some of the differences are age, religion, dialect, socioeconomic backgrounds, geographic locations, gender identities, gender roles, and the degree of values that are adopted in a current country.

Stereotyping is something a nurse must learn not to do because culture can influence each person in varies ways and not each person from a certain culture may feel the same way as another person. Stereotyping is a generalized feeling about one group that is formed based on behavior, of an individual or a group. Ethnic stereotyping is a fixed concept of how all members of a certain group may think or act.

Race is considered a group of people who share biologic and physical characteristics, while ethnicity is a group of people who share a common social and cultural heritage based on beliefs, traditions, and national origin, physical and biologic characteristics.

Transcultural nursing is the understanding and integrating of the many variables in culture and subculture practices into all the aspects of nursing care. Different cultures have a variety of practices that may relate to response to illness and death, care of people of different age groups, childbirth, diet and nutrition, and even health care in general and treatment methods.

The nurse must be aware of personal culture beliefs and practices of their patient and understand that these beliefs put influence on their ability to care for those patients of different cultural backgrounds. By understanding these personal beliefs it gives the nurse the ability to react to different cultures with understanding, respect, openness, and acceptance of the differences between them. Depending on the location you work you may come across many different cultures and subcultures it is a nurse's duty to become versed in the different patients they may take care of.

Shyanne Reese prefers to call herself a "conqueror" rather than a survivor of breast cancer. She revels in her personal triumph, defeating the foe that threatened her life in 2008, and is now moving forward with poise and purpose.

However, Reese didn't always feel so confident. In fact, as an African-American, she says cultural myths long held her back from seeking treatment or even giving herself breast exams.

"Culturally, it's been taboo to discuss cancer in the African-American community, so a lot of women suffer in silence or don't seek treatment when they should," said Reese, 59, who works in the insurance industry and volunteers as a community health advocate for the Women's Cancer.

Cancer "conqueror" Shyanne Reese, who volunteers for the Women's Cancer Resource Center, is photographed in Oakland on Sept. 12, 2012. (Kristopher Skinner/Staff) Resource Center in Oakland. She reaches out to women at churches and health expos, leading the center's Sister to Sister support group for black women and even helping them navigate the health care system. "And I had my own personal battles. My mother had instilled in me a belief that it was wrong or sinful to touch myself, so I had never done self exams."

Indeed, as health advocates work to draw attention to the disease for all women during October's National Breast Cancer Awareness Month, many point to recent studies -- such as one from Sinai Urban Health Institute in Chicago, which examined statistics from 25 major U.S. cities -- that confirm a fact physicians and advocates have known for decades: while Caucasian women have a higher incidence of breast cancer, women of color are more likely to die from it, chiefly because of cultural, social and economic factors that lead to late detection and treatment.

"There's a history of silence around cancer in the African-American community," said Peggy McGuire, executive director of the Women's Cancer Resource Center, which provides programs for low-income black women and Latinas. "Part of the problem is that they see themselves as the caregivers of the family and put themselves second. There's a reluctance to admit they are ill."

In addition, many say there's embarrassment and guilt -- as though a woman has done something to cause the disease. That combined with a "what I don't know won't hurt me" mentality is a recipe for avoidance behavior.

"There's also distrust of the medical community," McGuire said. "And, of course, poverty is the most significant factor because women likely lack health insurance, have poor nutrition -- even just living in neighborhoods with violence is a factor. The stress accompanying that has a significant effect on immune systems."

At Latinas Contra Cancer in San Jose, advocates have encountered unique cultural barriers for Latino women.

"For Latinas, cancer is often seen as a death sentence. It's kind of, 'If I've got it, that means I'm gonna die, so I don't want to know,' " said Ysabel Duron, Latinas Contra Cancer founder, KRON-TV news anchor and a cancer survivor/conqueror. "And there are religious barriers. Some see it as a punishment from God, that they must have done something wrong and deserve it. Or they'll say their husbands won't let them get a checkup -- no other man should be touching them.

"These are the things we try to break through. It's really about getting into those communities and literally taking them by the hand and navigating them through this."

Angelica Nuno, 24, of Oakland, did just that with her aunt a few years ago, helping her with translations, filling out forms, sitting with her in the doctor's office. Nuno now volunteers as a community health advocate for the Women's Cancer Resource Center.

"I saw how hard it was for my aunt with the language barrier, so I wanted to help," she said. "A lot of women in that situation are scared to even approach a hospital. They don't know you can get free mammograms and support."

While the medical community is learning more about societal issues affecting Latinas and African-American women with breast cancer, even less research has been done for Middle Eastern, Pacific Islander or other groups, Duron said.

"They're where African-American and Latinas were 15 years ago as far as research goes," she said.

Advocates in nonprofit assistance organizations hope health care reform will address some of the disparities in mortality rates by increasing cultural sensitivity training for mainstream care providers, Duron said. In the meantime, much of that kind of support falls to independent groups. And to volunteers like Reese.

By 2008, Reese was making big changes in her life. She had reached her weight-loss goal, dropping 101 pounds. And through her increasing education about women's health, -- which she said she had to go outside her family to find -- she had finally become comfortable with self breast exams.

"Something felt different," she said. "I didn't know if it was because of the weight loss. But going in to get it checked out -- I still felt embarrassment and guilt, like maybe I had caused this myself somehow because of carrying the weight for so long."

When her cancer was diagnosed, the same week she was laid off from her job, she was asked at the hospital if she wanted to have a social worker as a support person. She said no.

"It was all just overwhelming, and when I did decide I needed support, I wanted someone who looked like me, but there was no one available. It was so embarrassing to say that I needed help that way. African-American women are taught they don't need help and suffer isolation sometimes. So the challenge was to say, yes I want help."

Reese, who had surgeries on both breasts, has been cancer-free for nearly three years now.

"For me, breast cancer has been a gift," she said. "I knew I had a purpose in life, and it's finally been revealed -- to do what I do now, to reach out and help other women."

In nursing school, we are taught to respect the rights and dignity of all clients. As the “world becomes smaller” and individuals and societies become more mobile, we are increasingly able to interact with individuals from other cultures. Cultural competence and respect for others becomes especially important for us asnurses and patient advocates.

We all begin the process of learning the behaviors and beliefs of our culture at birth. We become assimilated into that culture, and the way that we express it is often without conscious thought. Our culture can have a definite and profound effect on how we interact with others, and also how we relate to the health care system.

Diversity is prevalent in our society and the clients and our co-workers in our health care system today clearly demonstrate that fact. The development of cultural competence first requires us to have an awareness of the fact that many belief systems exist. At times, the healthcare practices of others may seem strange or meaningless. The beliefs that others have about medical care in this country, and sometimes their aversion to it, may be difficult for us to understand. We must remember that we don’t need to understand these beliefs completely, but we do need to respect them.

Barriers to cultural sensitivity can include stereotyping, discrimination, racism, and prejudice. There are situations in which we may portray a lack of sensitivity without realizing it or intending to offend someone else. Simple steps such as addressing clients by their last name or asking how they wish to be addressed demonstrate respect. Never make assumptions about other individuals or their beliefs. Ask questions about cultural practices in a professional and thoughtful manner, if necessary. Find out what the client knows about health problems and treatments. Show respect for the client’s support group, whether it is composed of family, friends, religious leaders, etc. Understand where men and women fit in the client’s society. For example, in some cultures, the oldest male is the decision-maker for the rest of the family, even with regards to treatment decisions. Most importantly, make an effort to gain the client’s trust. This may take time, however all will benefit if this is accomplished. If the client does not speak your language, attempt to find someone who can serve as an interpreter.

Cultural competence is the ability to provide effective care for clients who come from different cultures. It requires sensitivity and effective communication, both verbally and non-verbally. As a nursing profession, we are far from representative of the populations that we serve. Members of minorities make up only a small percentage of nurses in the U.S. This number has been estimated to be as low as ten percent. The important issues of recruitment into the profession should specifically include efforts to recruit minorities and individuals from other cultures. When working with these individuals, the same principles apply as those listed above. Respect each other as a part of the health care team; we all are working towards the same goals of providing safe patient care.

Cultural sensitivity and cultural competence are an important part of the nursing care that we provide. Respect for others is discussed in our basic introductory courses in nursing school. It may have been a while since we heard how important it is in the development of an effective nurse/client relationship, but unlike some aspects of nursing, this will never change.

Diversity and inclusion is an evolving field. As a learner and practitioner, I work to embrace the expanding definitions while respecting the importance of the historic diversity topics of race and gender.

How we approach conversations about difference can determine how we embrace new definitions of identity, and the “agility” needed to learn, grow, and support all people in organizations.

Multiracial people are one of the fastest growing groups in the United States. As Andrea Williams mentioned in her article about multiracial students in the April/May 2012 issue of INSIGHT Into Diversity, “the 2010 Census marked the second time in the survey’s history that responders were allowed to check more than one box regarding their race; the first was in 2000. And as a result, demographers now have access to data that allows for comprehensive comparison and charting of the mixed race population. The results are remarkable: from 2000 to 2010, the number of multiracial American children – who will soon be attending colleges and universities across the country – rose by almost 50%, to 4.2 million.

The changing demographics have inspired people to create language like “the multicultural generation” and “ethnically ambiguous,” among others. Williams’ article presents some important reflection about creating schools and universities that support multiracial students.

Not-for-profit organizations and corporations will also need to update their language, understanding, and awareness to include multiracial employees, and employees with multiracial families.

A June 2012 Fast Company article talked about the importance of “cultural agility.” They defined “cultural agility” as “the capacity to recognize, understand, and respond appropriately to various cultures, and to work within those cultures to achieve business results.” The language of “agility” is also highlighted in the Center for Creative Leadership’s recent newsletter. They talk about flexibility and agility as a key to leadership. Agility is an important part of the learning and awareness in diversity and inclusion. Multiracial identity is not new, nor is the presence of multiracial families in our organizations.

There is a global history of multiracial people. There is a substantial scholarship focusing on the role of multiracial people in our history, media, etc. What we have not seen at the same level is the inclusion of multiracial people in diversity and inclusion dialogues and programs. As a multiracial global diversity and inclusion practitioner and coach, I have learned that, as with all diversity topics, there are varying levels of awareness about what multiracial identity means to employees and to diversity and inclusion initiatives.

One of the first times that I was part of a professional “group” of multiracial individuals was while attending a Working Mother Media Women’s conference. I remember feeling the uniqueness of the experience.

Participants in workshops or present at some of my speeches would approach me and talk about their “invisible diversity,” which for some meant their multiracial identity. For others, it meant their partner, spouse, or child of a different race. Often they swapped tales of not having a place to share their diversity stories.

The presence of multiracial individuals and families can challenge our notions and comfort around talking about race and history, race and families, and race and racism.

Multiracial individuals and families are part of the changing workforce. In the spirit of learning agility, I would suggest that organizations learn to incorporate language and programs that include multiracial individuals and families.

We can continue to be “agile” in our learning about multiracial identity by:

Assessing data collection that does not allow for identifying as multiracial individuals and families;

Including multiracial groups as part of the growing affinity/ERG/Networking groups within organizations;

Allowing multiracial people to self-identify – and not identify employees based upon what we observe;

Updating our language and communication to include multiracial identity and;

Learning more about national groups (SWIRL, MAVIN, etc.) that address multiracial identity and families.

Our learning and growth continues as long as we remain “agile.” The inclusion of more stories, experiences, and identities makes the journey even richer.

Tanya Odom, Ed.M, is a part-time Senior Consultant with The FutureWork Institute and a member of the INSIGHT Into Diversity Editorial Board.

There is a lot of attention being paid to our increasingly diverse workplace. There are all types of differences including race, gender, generations and thinking styles, just to name a few. LTAW’s focus this month is on some of the key diversity dimensions and how to navigate them for greater productivity and engagement.

The increasingly diverse global workforce has made cultural competence an imperative to sustain and enhance workplace performance and engagement. What is culture and what is cultural competence? Culture is the behavioral interpretation of how a group lives out its values in order to survive and thrive; the set of shared attitudes, beliefs, behaviors, values, goals, and practices that characterizes an institution, organization or group. Cultural competence is the capability to shift cultural perspective and adapt behavior to cultural commonalities and differences. Ongoing, continued learning is required for cultural competence.

The three largest minority groups in the US workforce today are: Hispanic/Latino (14.7%), Black/African-American (11.6%), and Asian American (4.6%). The more different cultures work together, the more cultural competence is essential to avoid problems ranging from miscommunication to actual conflict. These problems can compromise effective worker productivity and performance.

Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures. The purpose of this post is to understand the different barriers and hurdles that minority groups tend to face in the workplace. Managers must understand that their style cannot necessarily be “one size fits all” if they have a multi-cultural team. Below are some characteristics of the three main minority groups in the workplace.

Hispanics/Latinos

Hispanic culture tends to be risk adverse and more of a “we” vs. “I” culture. This can negatively impact them in the workplace if it is not understood. Their risk avoiding nature may not afford them the same chances to show their abilities and skills. By not self-promoting as much as others, Hispanics may not be rewarded for their contributions.

Cultural competence can help Hispanics reach their full potential in the workplace. Many employees make sweeping stereotypes about Hispanics. Some are criticized for their accents, leading to assumptions on their abilities, level of education, and intelligence. Hispanics tend to speak Spanish with each other because of comfort, but this can be confusing or seen to be exclusionary by others.

Mentoring can make the difference in retaining Hispanics. Hispanic mentors serve as role models and better understand some of the cultural nuances of being Latino in the workplace. Hispanic employees need formal and informal ways to connect with each other in order to maintain the relationship bonds they value.

Blacks/African Americans

Studies tell us that there is greater corporate flight amongst minorities, especially among African Americans. Research conducted by the WP Carey School of Business showed that the predicted quit rate for whites was 3.73%, compared to 4.79% for African Americans. Discriminatory environments and micro-behaviors are often cited as reasons African Americans leave an organization. So what can a company do to make these employees feel more engaged? Based on findings from focus groups conducted by the Future Work Institute, the top five characteristics of an organization that retains African American employees include:

A climate of inclusion Supportive interactions with leaders Offer of profit and loss responsibilities Opportunities for development and advancement at all levels Community involvement and social responsibility

As with Hispanics, mentoring is a key factor in the career development and retention of Blacks/African Americans. Studies have shown that mentoring of African Americans leads to: increased performance, faster promotion rate, early career rate of advancement, greater upward mobility, higher income, job satisfaction and perceptions of great success and influence in an organization.

African Americans place a high value on interpersonal relationships with supervisors and co-workers, which impacts both job satisfaction and employee commitment. Supportive work environments for African Americans include: collectivist (focus on group rather than individual outcomes) approaches to work, agreeableness and teamwork.

Asian Americans

The same Future Work Institute focus group study revealed the major hurdles for Asian Americans in the workplace. The primary reasons that Asian Americans feel excluded in the workplace include:

Lack of mentors with Asian perspective. Because of the small number of Asian Americans in the US workforce, mentors with Asian perspective are limited. Similar to Hispanics and African Americans, Asian Americans would benefit greatly from having mentors in the workplace. Glass ceiling. Asian Americans who wish to move up the career ladder feel limited because they do not see Asian representation at the top. Lack of transparency. The need for constructive feedback is essential for career development. Life is out of balance. Often caught between the demands of kids, parents and work, Asian Americans feel their work and life is out of balance. According to AARP, 73%of Asian Americans believe that children in their families should care for elderly parents, compared with 49%of the general population. Cultural differences. The sentiment from many Asian Americans is that, “Our culture is very different from the _______ culture.” There is a lack of cultural understanding which is a barrier for them in the workplace.

It is important to note that the data presented above does not apply to every person within that subgroup and that any generalizations should not be viewed as stereotypes. We offer this information to provide guidance to leaders on how the differences in values and culture might influence workplace behaviors and needs and why cultural competence is such a vital skill for leaders to effectively manage the increasingly diverse workforce.

Many tribal cultures don't have a word for "boredom". Sitting under a tree for hours at a time, waiting in line to get water from the well, or walking four days to a nearby village for medical help is just a way of life. But as technological advances penetrate societies all over the globe, impatience is mounting everywhere.

Google slowed down the speed of search results by four tenths of a second to see what impact it would have. The result was eight million fewer searches a day! A quarter of us abandon a webpage if it doesn't load within four seconds. An email that doesn't get a response within 24 hours is considered unresponsive. And one USA Today study found that most North Americans won't wait in line for more than 15 minutes.

But "impatience" + "cross-cultural" don't work well together. Cross-cultural relationships and projects inevitably take more time, more effort, and more patience. Slowing down often goes against the grain of what we're trying to accomplish.

A volunteer construction team from the U.S. traveled to Liberia to put a roof on a Monrovian school. The Liberians were extremely grateful for the N. Americans' generosity but the first day into the project, the Liberians expressed concern about whether the new roof would be well-suited to the Monrovian climate and environment.

When they voiced their concern, the volunteers replied, "Look. You have to trust us. We've worked on buildings like this all over the world. We're only here for six days. So the only way we'll get this done is if we stick with our plan."

Three months later, a monsoon came in off the Atlantic coast and the new roof came crashing down. A couple Liberian students died and several others were injured. Sometimes our "efficient"(impatient!) approach is not so great after all.

Just about everything takes longer when working and relating cross-culturally. Communication, trust-building, and just getting things done requires more effort and perseverance. Whether it's dealing with long queues when traveling, merging different technology systems, or trying to get to the bottom of a conflict, understanding and effectiveness come more slowly when different cultures are involved.

Patience needs to be factored in from the very beginning of any cross-cultural project. Long before the U.S. construction team ever arrived in Liberia, a more thorough process of determining what the need was and how to best meet it would have been valuable.

For a fraction of the cost of shipping a team to Africa, the volunteers could have sent money to have local builders put on a new roof. Or with a deeper level of analysis, they may have concluded that the roof wasn't really the problem but instead, was a symptom of deeper problems of poverty and conflict that could be better addressed by partnering with development experts.

Full disclosure. I'm terribly impatient. I hate waiting in lines, I calculate which driving lane is moving fastest, and I want things to happen quickly and according to plan. But on the rare occasion when I exercise patience, the end result is almost always better: the partnership is richer, the project gains wider acceptance, and the money invested goes further.

In a world of instant information and feedback, it's counterintuitive to step back and move more slowly. But slow is the new fast when you're working across cultures. Take a deep breath and trust that something far bigger and better can be accomplished when you patiently persevere through the hard work of listening, understanding, and discovering the possibilities that may otherwise go unnoticed when rushing to the finish line.

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnlineTM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

Cost questions

There are still plenty of questions regarding professional interpreters, according to Flores.For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

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Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?

Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.

Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.

Models

Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.

The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.

Staff should select a model that best fits your specific work setting and patient population.

Beware stereotypes

Discussions about culture in healthcare often focus on race and ethnicity. Taking this approach excludes other factors (biological, psychological, religious, economical, political) that are all aspects of one's cultural experience. When race and ethnicity are overemphasized in conversations about healthcare disparities, the results can be polarizing because nursing remains a White, female-dominated profession. Also, emphasis on racial difference over other equally important differences sets up an "us versus them" dynamic between nurses that may lead to some minority nurses' disengagement from these initiatives. In addition, no one is immune to prejudice. Minorities are just as likely to have room for improvement in cultural competency.

Taking it all in

You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.

To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.

In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.

Goals and Considerations of cultural competency

How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:

* What does being culturally competent mean to me and the patients I serve?

To combat the high toll of HIV and AIDS among black women in the United States, the Centers for Disease Control and Prevention today launched Take Charge. Take the Test., a new campaign to increase HIV testing and awareness among African-American women. The campaign – which features advertising, a website and community outreach – is being launched in conjunction with National Women and Girls HIV/AIDS Awareness Day in 10 cities where black women are especially hard-hit by the disease.

“At current rates, nearly 1 in 30 African-American women will be diagnosed with HIV in their lifetimes,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “To help reduce this toll we are working to remind black women that they have the power to learn their HIV status, protect themselves from this disease, and take charge of their health.”

The program is being launched in Atlanta; Chicago; Detroit; Fort Lauderdale, Fla.; Houston; Memphis, Tenn.; Newark, N.J.; New Orleans; Hyattsville, Md.; and St. Louis.

Take Charge. Take the Test. is part of CDC’s commitment to address the urgent HIV prevention needs of African-American women, who are far more heavily affected by HIV and AIDS than women of any other race or ethnicity in the United States. African-American women account for nearly 60 percent of all new HIV infections among women (and 13 percent of new infections overall). The rate of new infections among black women is 15 times higher than among white women.

The campaign emphasizes the importance of HIV testing as a gateway to peace of mind and better health. Campaign messages will reach black women through a variety of highly visible channels, including outdoor and transit advertising; radio ads; posters and handouts distributed in salons, stores, community organizations, and other venues; campaign ads and materials on health department and partner websites; and a dedicated campaign website,http://hivtest.org/takecharge, where women can find HIV testing locations in their communities.

In addition to promoting HIV testing, the campaign encourages African-American women to talk openly with their partners about HIV and insist on safe sex, and to bring these same messages to other women in social settings, workplaces, living rooms, and religious congregations.

Take Charge. Take the Test. reflects a strong partnership between CDC, health departments, and local organizations in the 10 participating cities, which worked together to develop local campaigns for the communities they serve. The campaign was initially piloted in Cleveland and Philadelphia, where Take Charge. Take the Test. community events were attended by nearly 10,000 women, and campaign messages were seen more than 100 million times.

“We hope to extend the reach of this campaign to multiple cities throughout the nation, help empower many more women to take control of their health, and help break the silence about HIV in their communities,” said Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention (DHAP).

Research shows that black women are no more likely than women of other races to engage in risky behaviors. But a range of social and environmental factors put them at greater risk for HIV infection. These include higher prevalence of HIV and other sexually transmitted infections in some black communities, which increase the likelihood of infection with each sexual encounter. Limited access to health care can prevent women from getting HIV tested. Research also shows that financial dependence on male partners may limit some women’s ability to negotiate safe sex. HIV stigma, far too prevalent in all communities, may also discourage black women from seeking HIV testing.

“This campaign is just one part of the solution,” said Donna Hubbard McCree, Ph.D., associate director for health equity at DHAP. “All of us have a role to play in stopping the spread of HIV among black women – by talking to our sisters, daughters, husbands, and boyfriends about how to protect ourselves against HIV and the importance of getting tested; by speaking out against stigma; and by tackling the social inequities that place so many of us at risk for HIV.”

Take Charge. Take the Test. is the latest campaign of CDC’s Act Against AIDS initiative (http://actagainstaids.org) a five-year, $45 million national communication campaign to combat complacency about the HIV/AIDS crisis in the United States. The campaign also directly addresses the goals of the National HIV/AIDS Strategy, which calls for reducing new infections, intensifying HIV prevention efforts in communities in which HIV is most heavily concentrated, and reducing HIV-related deaths in communities at high risk for HIV infection. Other Act Against AIDS campaigns include those targeting high-risk populations such as gay and bisexual men, as well as efforts to reach health care providers and the general public.